Home Health Agency (HHA) Center

• Jimmo v. Sebelius Settlement Agreement (Fact Sheet) - On January 24, 2013, the U. S. District Court for the District of Vermont approved a settlement agreement in the case of Jimmo v. Sebelius.  For additional information, please see the Jimmo v. Sebelius Settlement Agreement Fact Sheet.

• Ordering and Referring Denial Edits Will Turn on May 1, 2013
  
  Effective May 1, 2013, CMS will instruct contractors to turn on Phase 2 denial edits on the following claims to check for a valid individual National Provider Identifier (NPI) and to deny the claim when this information is missing
  • Medicare Part B claims including Durable Medical Equipment, Orthotics, and Supplies (DMEPOS) that have an ordering or referring physician/non-physician provider; and
  • Part A Home Health Agency (HHA) claims that require an attending physician provider.

  For more information:

  Attend the National Provider Call on March 20 from 3-4:30ET. Register Now.

  MLN Matters® Article #SE1305, "Full Implementation of Edits on the Ordering/Referring Providers in Medicare Part B, DME, and Part A Home Health Agency (HHA) Claims"

         “Medicare Enrollment Guidelines for Ordering/Referring Providers”

         “The Basics of Medicare Enrollment for Physicians Who Infrequently Receive Medicare Reimbursement”

• On March 1, 2013 CMS released updated face-to-face encounter Q&As and therapy Q&As to provide guidance for physicians, non-physician practitioners, physician support personnel, and home health agencies on compliance with the face-to-face encounter and therapy reassessment requirements, including the changes to those policies that were made in the CY 2013 Home Health Prospective Payment System Refinements and Rate Update, Hospice Quality Reporting Requirements, and Survey and Enforcement Requirements for Home Health Agencies Final Rule (CMS-1358-F).
• CY 2013 Home Health Prospective Payment System Refinements and Rate Update, Hospice Quality Reporting Requirements, and Survey and Enforcement Requirements for Home Health Agencies (CMS-1358-F).  A final rule was displayed at the Federal Register to update Medicare's Home Health Prospective Payment System (HH PPS) payment rates for Calendar Year (CY) 2013.  Payments to home health agencies (HHAs) are estimated to decrease by approximately 0.01 percent, or -$10 million in CY 2013, reflecting the combined effects of the home health payment update ($260 million increase), wage index updates ($70 million decrease), a new FDL ratio ($50 million increase), and reductions to the HH PPS to account for a 1.32 percent case-mix coding adjustment ($250 million decrease).  The rule also rebases and revises the home health market basket, allows additional regulatory flexibility regarding therapy documentation and reassessments as well as face-to-face encounter requirements, discusses the transition plan for ICD-10, and provides information on the home health study concerning home health care access.  Lastly, this rule implements new requirements concerning the hospice quality reporting program and will establish requirements for unannounced, standard, and extended surveys of home health agencies (HHAs) and provide a number of alternative (or intermediate) sanctions that could be imposed if HHAs were out of compliance with Federal requirements.  The provisions in this final rule are effective for episodes ending on or after January 1, 2013, unless otherwise specified in the final rule.  For episodes that begin in CY 2012 and end in CY 2013, the therapy provisions of this final rule do not apply.  The therapy provisions of this final rule are applicable to episodes that begin on or after January 1, 2013.
• Vaccination is the Best Protection Against the Flu [PDF, 414KB]